Two largest accrediting bodies adopt outcomes-based standards

The nation's two largest correctional accrediting bodies have rewritten their accreditation standards to make them more outcomes based and oriented, changes that will profoundly influence the delivery and provision of health care services within correctional settings.

The American Correctional

"Essentially, performance based means accreditation based on resuits," says Kathleen McKim, RN, administrator of Health Care Programs for ACA, which represents more than 20,000 correctional employees.

"Each health care standard defines a goal or condition that needs to be achieved and maintained. The old standards outlined activities instead of goals."

The previous ACA accreditation standards, for example, listed access to care as a standard, a process more readily defined as an activity than an outcomes based measurement. Under the new standards, access to care comprises one component of an expected practice, one of several practices that constitutes an overall performance standard.

"The new performance standard says that offenders will have unimpeded access to a continuum of health care services," explains McKim, citing an example.

"The activities are now expected practices. When we go in and audit those expected practices, they add up to a performance based standard."

McKim describes the performance based standards as proactive "measurement tools," that will enable correctional institutions to identify and correct problems while striving for continuous quality improvement (CQI).

ACA officials spent three years revamping the standards before unveiling the current performance based measurements for field tests in July 2000.

So far one correctional institution, the David Wade Correctional Center in Homer, La., has undergone ACA's accreditation process with the new standards, obtaining accreditation from the organization early this year.

ACA has six more field tests scheduled this year, which will be used to fine-tune the accreditation standards.

"We are taking the standards that have been approved by our standards committee and implementing it in.facilities," McKim explains. "Correctional officials are going to give us feedback after our auditors come through. They are still being accredited and held to this version but they are going to be able to voice their opinions and recommendations to help with the evolution of the process."

Not surprisingly, McKim expects the standards to dramatically elevate the level of care in correctional institutions, explaining that the standards "fit into the whole component of continuous quality improvement."

NCCHC, meanwhile, rewrote its accreditation standards by making them more prospective and placing a greater emphasis on quality improvement, says NCCHC Vice President Scott Chavez.

NCCHC accredits about 500 jails and prisons.

"It is making what we have been saying explicit instead of implicit," explains Chavez.

The new NCCHC standards have been recast and simplified, making them easier to understand and apply, Chavez says.

"Those are the biggest changes that people are going to see-more explanation, more depth and more quality improvement," he says.

Chavez refers to the new standards as a "system approach" that will improve correctional health care while making it more efficient and cost effective.

The organization will post a draft version of the standards on its Website for comment this summer, publishing a final version in the fall, Chavez says.

NCCHC devoted five sessions to corrections-based systems research during its annual National Conference on Correctional Health Care in St. Louis last September, the first time it held sessions on systems research.

Dr. Tom Conklin, health services director for the Hampden County, Mass., Correctional Center called the sessions a "wonderful development that can only benefit each of us in-particular and the field of correctional medicine in general."

"It is through research that we will be able to address our chronic and severe funding problems and demonstrate the need for medical services to be at a community level of care for all correctional programs," he says.

"It will be research that will one day propel correctional medicine into its rightful place as a recognized subspecialty."

The decision by ACA and the NCCHC to focus more on outcomes reflects a larger trend occurring in the public and private sectors.

"Systems of health care are being subjected to measurements looking at how well they perform," says one analyst. "We are starting to enter into an era of medicine that says, `what is the evidence that this intervention actually works."'

Correctional medicine will not escape this type of scrutiny.

"We have a lot of anecdotal and verbal presentations," says Chavez. "The problem is we have not taken the next step of actually translating it into the written word and publishing it in peer review journals and being a part of the scientific community so that it can be analyzed and scrutinized."

Inf.: Chavez, 773-880-1460; www.ncchc.org; McKim, 301-918-1848; www. aca. org.

(Abstracted from Positive Populations In Prisons, a newsletter on infectious disease policies in corrections, 202-518-7768.)